Real World Incidence and Etiology of Infectious Complications in Adults With Ph‐Negative Acute Lymphoblastic Leukemia Treated With the Pediatric‐Inspired GIMEMA LAL1913 Program. A Campus All Study

Infections often complicate pediatric-inspired treatments for adult Philadelphia-negative acute lymphoblastic leukemia (Ph- ALL). Literature data on these complications are difficult to interpret due to the heterogeneity of types of infections analyzed or patients and treatment characteristics. A deeper insight on the infections occurring in the real life in uniformly treated ALL patients is lacking. This study investigated infectious complications in 240 newly diagnosed adult Ph- ALL patients treated in the real life according to the GIMEMA LAL1913 protocol by 18 Italian centers participating in the Campus ALL network. Incidence, etiology of microbiologically documented infections and invasive fungal infections (IFI) and mortality for infection were determined. Potential risk factors and the prophylactic strategies used during the first chemotherapy course (C1) were analyzed. Of 240 patients, 145 (60%) experienced at least one infectious episode, with bacterial infections being the most common (74.3%), followed by viral (13.9%), fungal (10.1%), and Pneumocystis jirovecii (1.7%) infections. The blood stream was the most involved site, pneumonia occurred in 14.6% of cases, half of which being fungal. Infections were prevalent during C1, affecting 40.5% of patients; IFI occurred in 12.5% of patients, most of them in C1. Risk factors for infections included older age (≥ 55 years and particularly > 65 years) and comorbidities only for IFI. The mortality rate for infection was 3.3%. Antibacterial, antiviral, antifungal, and anti-PJ prophylaxis were variably administered and did not associate with a significant reduced infection rate. In conclusion, the rate of infectious complications in the real life of adult Ph- ALL patients treated with a pediatric-inspired intensive regimen is high, mainly during induction and mostly bacterial, particularly in the bloodstream, with a high IFI rate. Older age, mainly over 65 years, is a risk factor for all types of infection. The antimicrobial prophylaxis was not associated to a reduced risk of infection.

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Publication Details

Journal
Hematological Oncology
Published
2025-08-11
DOI
https://doi.org/10.1002/hon.70121
Citations
2
Primary Topic
Antifungal resistance and susceptibility
Type
article
Field-Weighted Citation Impact
2.79
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article

Real World Incidence and Etiology of Infectious Complications in Adults With Ph‐Negative Acute Lymphoblastic Leukemia Treated With the Pediatric‐Inspired GIMEMA LAL1913 Program. A Campus All Study

Fabio Forghieri, Anna Candoni, Fabio Guolo, Elisa Roncoroni et al.
2 citations
Hematological Oncology
Antifungal resistance and susceptibility
2.79
article

Real World Incidence and Etiology of Infectious Complications in Adults With Ph‐Negative Acute Lymphoblastic Leukemia Treated With the Pediatric‐Inspired GIMEMA LAL1913 Program. A Campus All Study

Fabio Forghieri, Anna Candoni, Fabio Guolo, Elisa Roncoroni, Virginia Valeria Ferretti, Michelina Dargenio, Brahma P. Sani, Luca Arcaini, Sara Mastaglio, Sabina Chiaretti, Marco Cerrano, Cristina Papayannidis, Maria Ilaria Del Principe, Marianna Rossi, Gianluca Martini, Valentina Mancini, Monia Lunghi, Davide Lazzarotto, Carla Mazzone, Claudia Cabrera, Patrizia Zappasodi, Marzia Defina, Ludovica Calabretta, Crescenza Pasciolla, Maria Ciccone, Giacomo Riccaboni, Nicola Stefano Fracchiolla, Robin Foà
article en
2 citations

Abstract

Infections often complicate pediatric-inspired treatments for adult Philadelphia-negative acute lymphoblastic leukemia (Ph- ALL). Literature data on these complications are difficult to interpret due to the heterogeneity of types of infections analyzed or patients and treatment characteristics. A deeper insight on the infections occurring in the real life in uniformly treated ALL patients is lacking. This study investigated infectious complications in 240 newly diagnosed adult Ph- ALL patients treated in the real life according to the GIMEMA LAL1913 protocol by 18 Italian centers participating in the Campus ALL network. Incidence, etiology of microbiologically documented infections and invasive fungal infections (IFI) and mortality for infection were determined. Potential risk factors and the prophylactic strategies used during the first chemotherapy course (C1) were analyzed. Of 240 patients, 145 (60%) experienced at least one infectious episode, with bacterial infections being the most common (74.3%), followed by viral (13.9%), fungal (10.1%), and Pneumocystis jirovecii (1.7%) infections. The blood stream was the most involved site, pneumonia occurred in 14.6% of cases, half of which being fungal. Infections were prevalent during C1, affecting 40.5% of patients; IFI occurred in 12.5% of patients, most of them in C1. Risk factors for infections included older age (≥ 55 years and particularly > 65 years) and comorbidities only for IFI. The mortality rate for infection was 3.3%. Antibacterial, antiviral, antifungal, and anti-PJ prophylaxis were variably administered and did not associate with a significant reduced infection rate. In conclusion, the rate of infectious complications in the real life of adult Ph- ALL patients treated with a pediatric-inspired intensive regimen is high, mainly during induction and mostly bacterial, particularly in the bloodstream, with a high IFI rate. Older age, mainly over 65 years, is a risk factor for all types of infection. The antimicrobial prophylaxis was not associated to a reduced risk of infection.

Hematological OncologyVol. 43(5)
University of Rome Tor Vergata (IT), Università degli Studi del Piemonte Orientale “Amedeo Avogadro” (IT), University of Pavia (IT), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT), Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT), Ospedale Maggiore (IT), Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT), Azienda Universitaria Ospedaliera Consorziale - Policlinico Bari (IT), Azienda Unità Sanitaria Locale di Ferrara (IT), Azienda Ospedaliero-Universitaria di Modena (IT), Istituto di Ematologia di Bologna (IT), Presidio Ospedaliero (IT), Ospedale Santa Maria della Misericordia di Udine (IT), Arcispedale Sant'Anna (IT), A. O. Ordine Mauriziano di Torino (IT), Azienda Ospedaliera Universitaria Senese (IT), St. Eugenio Hospital (IT), Ospedale Policlinico San Martino (IT), Policlinico San Matteo Fondazione (IT), Ospedale Vito Fazzi (IT), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Istituto Nazionale di Fisica Nucleare, Sezione di Roma I (IT), Gruppo Italiano per il Trapianto di Midollo Osseo (IT), Sapienza University of Rome (IT)
Good health and well-being
Openalex Percentile: Top 9%
Antifungal resistance and susceptibility
2.79
DOIOpen Access PDFOpenAlex
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